1. Field of the Invention
This invention relates to surgical instrumentation and more particularly to an instrument and "minimally invasive" method utilizing an inflatable envelope to bluntly dissect connective tissues that adhere between an organ and surrounding tissue preparatory to resection of the organ. The above-mentioned parent application Ser. No. 08/255,273 discloses an inflatable envelope for bluntly dissecting tissue and creating an anatomic space along a natural anatomic plane and a method for fiberoptically viewing and for performing a surgery around the surface of the inflated envelope. The method of the present application also provides for fiberoptically viewing around the exterior of the inflatable envelope and for performing a sharp dissection around the inflated envelope to facilitate the resection procedure.
2. Description of the Prior Art
Preparatory to resection (removal) of part or all of an organ or anatomic structure, surgeons in the past have used sharp-tipped instruments (e.g., a scalpel) to sharply dissect connective tissues that typically adhere between the organ and surrounding tissues to mobilize the organ. Surgeons also have utilized blunt instruments (e.g., a grasper or the human fingers) to bluntly dissect connective tissues around an organ to mobilize the organ.
An illustrative example of a resection procedure in which mobilization of the organ is difficult is a transhiatal esophagectomy. It typically is necessary to divide the esophagus in the throat and in the region of the gastroesophageal junction. To mobilize the esophagus, the surgeon reaches with his fingers blindly into the thoracic cavity from incisions in the throat and abdomen to bluntly dissect connective tissues around the esophagus. Such blind dissection with the fingers is undesirable. On occasion, it may be necessary to open the thoracic cavity which also is undesirable.
Another example of a resection procedure in which minimally invasive procedures are not practiced is the harvesting of a saphenous vein associated with a heart bypass procedure. Under current practice, an open surgical approach exposes the entire length of the vein in the thigh, requiring an incision 12 inches or more in length. Such an open procedure leaves undesirable scarring, is time-consuming and requires lengthy postoperative recuperation.
Other anatomic structures that may be candidates for resection vary widely. Resection of organs or parts of organs with the abdominal cavity is often necessary and the surgeon typically mobilizes such organs with his fingers in an open procedure. Under current practice, it is difficult to accomplish such abdominal resection procedures in a "minimally invasive" or endoscopic approach, in part, because of difficulties in mobilizing the organ. For this reason, an invention to facilitate the mobilization of the colon in a colectomy (colon resection) is disclosed in the above-referenced co-pending application: "Surgical Instrument and Method for Intraluminal Retraction of an Anatomic Structure" filed Aug. 9, 1994, Ser. No.
The above-described procedures have in common the difficulty of mobilizing and resecting an anatomic structure by any means other than an open surgical procedure. There is therefore a need for new instruments and methods for dissecting tissues that surround an anatomic structure to mobilize the structure preparatory to resection. More particularly, there is a need for a less invasive surgical approach for mobilizing an esophagus in a transhiatal esophagectomy, for mobilizing and resecting a saphenous vein and for mobilizing and resecting organs in an insufflated workspace.